Background/Purpose
RCVS is characterized by acute onset of severe headaches, with or without neurologic deficit with evidence of reversible cerebral vasoconstriction. We have previously reported data on long-term outcome on 20 patients with RCVS. Herein, we are validating our previous report by including data from two large academic centers.   

Objectives:
i) To assess stroke and headache outcomes using validated measures ii) To determine the impact of RCVS on health related quality of life (QoL). 

Methods
The following validated questionnaires were mailed to patients recruited from RCVS registries of Cleveland Clinic and Massachusetts General Hospital: Headache screening form, Headache Impact Test (HIT-6), Migraine Disability Assessment Test (MIDAS), Barthel Index (BI), EuroQoL (EQ-5D-5L) and Patient Health Questionnaire (PHQ-9).

Results
Of the 191 patients in the RCVS registries, 109 could be contacted and 45 responded to the questionnaires.  This included 41 (91%) females, with a median follow-up time after symptom onset of 78 months (range 4-254 months). Forty six % had prior migraine, 31% developed ischemic stroke, 18% intracerebral hemorrhage, and 44% had convexal subarachnoid hemorrhage. After RCVS resolution, 24 (53%) patients continued to have headache, but the majority (88%) reported improvement in its severity. Five (14%) patients reported severe impact on activities of daily living from headaches as measured by the HIT-6 and MIDAS scales. The majority (97.5%) of patients were functionally independent based on their BI scores. EQ-5D-5L measurements showed that patients did better in the domains of mobility, self-care and usual activities, as compared to pain and anxiety/depression. Patients with persistent headache had significantly higher levels of pain as measured by EQ-5D-5L. Depression assessment using the PHQ-9 revealed only 1 (3%) patient reporting severe depression. There was a trend towards greater patients with persistent headache having more severe degrees of depression. There was no difference among all the outcome measures between the two centers.  

Conclusion
More than half of patients with RCVS will continue to have headache long-term. They are not similar to the RCVS onset headache and are markedly improved from the initial headache. Although close to two-thirds of patients suffered from an initial ischemic or hemorrhagic stroke, almost all were independent with little functional disability.  However, pain and anxiety/depression might be associated with lower QoL Headache may be a potential factor aggravating pain and anxiety/depression in those patients with persistent headache. This larger data from two different centers validate our previous report.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/update-on-long-term-outcomes-after-reversible-cerebral-vasoconstriction-syndrome-rcvs/